…can create a world of change.

Monthly Archives: February 2013

Imagine an island prison where inmates are treated with dignity and respect. They are given unrestricted access to education and are allowed to choose a trade and perfect their skills. They earn income commensurate with their work, and participate in a fair economy which teaches financial responsibility. Most grow a significant portion of their own food in personal gardens, but have the option to purchase other items from the island’s supermarket. Prisoners can take part in numerous leisure activities, like swimming, biking, playing in a band, and even enjoying a sunbed during the winter months. They are given unrestricted access to communicating with family and friends, and are allowed weekly visits in private family rooms where conjugal relations are allowed. All inmates are given full medical and psychological treatment, as they themselves see fit. The prisoners are housed in communal, family-like “pods” but have the option of “retreat bungalows” for earned vacations. Sounds more like a fantastical island paradise and not a correctional facility, right? Its actually Norway’s Bastoy Prison, the world’s first self-sustaining ‘Ecological Prison’ that is turning into a de facto social experiment.

The prison’s Governor (akin to the US’s Warden), Arne Kvernvik Nilsen, is a clinical psychologist by profession. Nilsen coined the phrase of Bastoy being “an arena of developing responsibility” and explains further:

“Both society and the individual simply have to put aside their desire for revenge, and stop focusing on prisons as places of punishment and pain. Depriving a person of their freedom for a period of time is sufficient punishment in itself without any need whatsoever for harsh prison conditions. Bastoy takes the opposite approach to a conventional prison where prisoners are given no responsibility, locked up, fed and treated like animals and eventually end up behaving like animals. Here you are given personal responsibility and a job and asked to deal with all the challenges that entails. It is an arena in which the mind can heal, allowing prisoners to gain self-confidence, establish respect for themselves and in so doing respect for others too.”

And the numbers speak for themselves. Although Bastoy houses violent offenders (like murders and rapists), has no cells or bars, and even allows access to weapons for the inmates’ various jobs, there has not been one incident of violence on prison grounds. Most importantly is the fact that Bastoy has the lowest re-offending rate in all of Europe, by a landslide! To put it into perspective, the average re-offending rate across Europe is about 70-75 per cent; whereas, Bastoy rests at 17 per cent!

The prison is very much still in the assessment phase, and comes with its fair share of criticisms in outcome measures. Norway is one of the wealthiest, most sparsely populated, and most stable countries in the world. However, Governor Nilsen, points out that the ultimate goal is for decision-makers of the world to take note of the revolution in rehabilitation that is occurring in that tiny island prison, and at least ponder the idea of change to think of a penal institution being designed to heal rather than harm, and to generate hope instead of despair.

Born and raised a proud Virginian, I’ve unfortunately come to know that my state has a checkered history of making legislative decisions that are most definitely not for the “common wealth” of it’s constituents.

While doing research on the state of mental health treatment in Virginia, I have come across numerous statistics that corroborate what we as social workers see all too often.

On a good note, Virginia was able to improve from it’s 2006 rank of “D” and is currently offering more services to the mentally ill than many states with dismal numbers like Arkansas, Kentucky, Mississippi, South Dakota, Wyoming, and our dear ol’ neighbors, West Virginia. Virginia now is on the positive side of the national average; however, there still is a great amount of room for improvement.

Currently Virginia’s urgent needs towards mental health include:

Expand community services, including case management and crisis services

In recent years, the Treatment Advocacy Center has also identified another crucial barrier to treatment of mental illness. They specifically looked at the disproportionate number of mentally ill incarcerated within each of the 50 states. Regarding the odds of a seriously mentally ill individual being in jail or prison compared to a hospital, the odds in Virginia was 3.6 to 1 that they would be incarcerated. This means that in 2004–2005, throughout the state, there were almost four times more individuals with serious mental illnesses in jails and prisons than in hospitals. Virginia was ranked #32! Ouch.

In 2008 a Virginia state mental health commission estimated that “15 percent of all inmates in states prisons and jails are seriously mentally ill.” Roanoke County Sheriff Gerald Holt said it was 25 to 30 percent in his jail. In Virginia Beach, Sheriff Paul Lanteigne “estimated that it typically takes at least six months to find an available bed for a deranged inmate at Eastern State Hospital or a nearby psychiatric center. Scores of people are sitting in his jail today, long after they would normally have been released on minor charges, because they are too sick to be freed.”

In summary, national surveys and state reports both suggest that at least 15–20 percent of jail and prison inmates are seriously mentally ill. We have thus effectively returned to conditions that last existed in the United States in the 1840s:

It is imperative that we as dedicated Virginians, work to stop the “frequent flyer” cycle of mentally ill being incarcerated versus receiving necessary treatment. This will come from utilizing assisted outpatient treatment, implementing mental health courts, maintain critical assessments and evaluations of state and local policies and programs, shift state and federal funding to address current service gaps, and work on reliable prevention and intervention services to address mental health before an individual is deemed dangerous.

Just about every law, invention, treaty, and large-scale action has unintended consequences, which often alter society as a whole through a butterfly effect – like the ripples after a rock is thrown into a calm body of water.

The 19th Century French economist, Frederic Bastiat, warned of the dangers of unintended consequences in his classic essay That Which is Seen, and That Which is Not Seen. He taught that, “in the department of economy, an act, a habit, an institution, a law, gives birth not only to an effect, but to a series of effects. Of these effects, the first only is immediate; it manifests itself simultaneously with its cause – it is seen. The others unfold in succession – they are not seen: it is well for us, if they are foreseen.”

It wasn’t until the 20th Century that American sociologist Robert Merton popularized the concept of unintended consequences and provided several possible causes: ignorance in that not every possible outcome can be anticipated, error from incorrect analysis, immediate interest that take priority over long term goals, basic values that prohibits certain outcomes, and self-defeating prophecy where well-meaning worrywarts attempt to fix a problem before it even comes to fruition.

If we focus only on the visible effects of a proposed policy, we may not recognize the invisible effects until the harm is done. How is it our policy makers seem so oblivious to the latent effects of choices supposedly made for society’s benefit?

Just a few infamous examples:

Prohibition brought us bootleggers/gangsters and NASCAR (lest we all forget that moonshine runners were the originators of stock car racing!)

Passing NAFTA decimated Mexico’s agriculture industry and crippled their economy, leading to the vast influx of illegal immigration to the US.

The failed 1990s “War on Drugs” only served to solidify and consolidate the profitability of drug cartels.

Rent controlled housing was meant to help secure housing for low-income tenants, but essentially created a drought of quality in housing for most major cities.

Creating antibiotics saved millions, but now our bodies are unable to fight of “superbugs” that are resistant to our greatly outdated antibiotics

After undergrad (and in a former life) I worked in government relations and public policy for a medical non-profit in the DC-area. Fresh from a small town, I was completely content traipsing around the Capital for hearings, meetings, and the typical “schmooze fest” where every move made was well calculated and micromanaged in order to have the best odds at “winning.” Our goal was simple, pharmaceutical companies had long abandoned research and development on antibiotics (something you take for only a short period of time) for the more lucrative medical innovations like Viagra, breast implants, and medications that secure a life-time of use. Most antibiotics still used today were originally invented in the 40s and 50s, and for that reason the levels of antimicrobial resistance continues to skyrocket. The bill introduced to US Congress aimed to create a number of incentives for pharmaceutical companies, and urged them to abandon the bottom dollar in exchange for the common good. I organized lobby days, press briefings, trips to the CDC and pharmaceutical companies, and attended countless meetings with Congress and their limitless legislative assistants. Our initial support was huge – because you couldn’t deny the scientific evidence! Our thought was if you ran a facts-based campaign, how can anyone vote “nay”? As voting day arrived, I sat nervously waiting for the results. The bill was voted down. It didn’t just die… it was slaughtered, burned, tarred ‘n feathered! Over a year’s work was gone and I sat stunned, holding back tears. I started the job thinking that the opening theme of Mary Tyler Moore was my background music, yet here I sat with only a funeral dirge playing on repeat. My mentor, my boss, had been through this rodeo several times before. He merely shrugged and said, “Next time.” I stammered, “But why?” His response was simple, “Pharmaceutical companies are the top financial backers of the elections,” and re-elections were right around the corner. I was so disheartened and jaded by the process of our government; I left the job (perks and all) to find a new career path.

Let me go back for a second to Bastiat and the Broken Window Phallacy. The salient point is that destructive policies will destroy prosperity, regardless of the amount of “spin” that someone puts on the visible consequences. This short video does a great job of summarizing a highly debated theory:

It was almost two years later that my former boss contacted me out of the blue. A prominent congressman had lost a loved one to MRSA (the antimicrobial resistant strain of staphylococcus). He just so happened to be one of the early backers to our bill who appeared to thoroughly enjoy our lavish dinners and “legal donations,” yet ended up one of the turncoats that voted against us. He wrote my boss a cryptic letter that apologized for his “oversight.” He quoted Bastiat, and made sure to point out that he and many of his fellow senators had voted for their own immediate best interest. It wasn’t until that a “nasty little infection” affected his own life that he was able to say, “Oops, My bad.”

In some hypothetical alternate universe, our country would have an “Oops, My bad” list to save us from the bipartisan blame-game and come clean about negative unintended consequences. I’m pretty sure if the south has anything to say about this list… the US bringing Kudzu over from Japan would be near the top! This fast growing plant brought over to help with erosion has since created substantial environmental and fiscal consequences as the “Vine that ate the South.”

We teach our kids that it’s okay to make mistakes because it’s just part of the “growing pains” of life and meaning-making towards lessons learned and self-preservation. I would not only trust, but respect, my own government if they would just admit their own mistake. As Winston Churchill stated, “those who fail to learn from history are doomed to repeat it.”

For six months I’ve had the opportunity to intern as a therapist at a children’s acute psychiatric facility. It didn’t take long to see the competing agendas of all the key stakeholders: clinicians from various fields, parents, patients, the hospital, and insurance. I’ve bared witness to numerous parents begging and pleading for the mental help that their child so desperately needs, and listened to the heartbreaking stories of the children who struggle on a daily, or even hourly basis, to pretend to exist as “normal.” I’ve seen policies affect the quality of care, most specifically how insurance dictates a patient’s treatment and length of stay. I sometimes feel as though we spin a roulette wheel and see where chance lands each child on what service we’ll be allowed to provide, regardless of symptoms they present. I’ve sat around tables finagling with billing employees on a single word choice in a health record and how that could negatively impact coverage. The hospital even conducts strong-armed meetings, where the message is quite clear – more patients equals more money and better reporting numbers. I’ve seen pressure to lower admission criteria, which robs the bed of another child in crisis. I’ve also seen countless parents adamantly protesting the release of their child (and sadly, the mental health clinicians typically agree), yet show up on discharge day putting up yet another brave front and knowing we’ll probably see each other again next week. The clinicians always sense the fear, anxiety, and apprehension in the parents, and empathize with the utter lack of options throughout the state. Until there is a day where policies and control over care are put back into the hands of the patient, family, and clinicians, I know that other tragedies loom around the corner.

Football fanatics and apathetic viewers all seem to be able to unite for one single day throughout the year… Super Bowl!

I’ve seen Super Bowl parties big and small, but usually full of the the quintessential attendees: the “Walking-Football-Almanacs,” the “Nobody-Loves-This-Team-More-Than-Me,” the “Just-Jumped-On-The-Bandwagon,” the “I’m-Here-For-The-Free-Beer-And-Food,” and most importantly… the “Shhh-The-Commercials-Are-On.”

Now don’t get me wrong, I was born and raised in a family that indoctrinated the religion of football. Perhaps my first tantrum can be traced back to a poor call from a referee and my first football chant involved shouting “piss poor coaching” at the TV in melodic harmony with rest of my family. Growing up in a rural town in Appalachia only solidified the importance of football, as my hometown would resemble Varsity Blues during the rivalry game (albeit we only had two teams). As a kid and teenager, my favorite memories revolved around football games: from being a majorette and cheerleader, to captain of the color guard, to a bonafide marching band geek.

Now here is where two roads diverge in a wood…

Over the years, my die-hard passion has mellowed to lukewarm. For no single reason, I no longer plan my Sunday and Monday nights around the game schedules of my favorite teams, or save up ludicris amounts of money to sit in a small seat, with 7 layers of clothes, sipping on $12 beers, just to see the action in person. I have become that apathetic viewer, but just don’t tell my family.

Super Bowl 2013 is like every other year for me, as I planned to continue my role of apathetic viewer to watch the game with the rest of the world… yes, world. It is estimated that 71% of every home with a TV in the United States was tuned into the Superbowl. My own brother stationed in Europe sat camped around with hoards of other military service men to participate in the obligatory celebration.

Think about this: Super Bowl has the ultimate platform. In between watching men violently pummel each other to run a small ball back and forth across a well manicured lawn, we are elated to watch 30-90 second commercials (you know, the very thing we pay our high-dollar DVRs to skip on a day-to-day basis.) I’ll admit, the commercials are great. They are well researched and planned by the most influential marketing firms, sometimes over a year in advance. By May 2012, over half of all the commercial slots had already been sold. Super Bowl XLVII (2013) continued the trend in commercial cost, by setting a new record average of $4,000,000 per 30 seconds of marketing (“average,” as in many paid more!).

So here is my food for thought → Just imagine! Imagine what our country could do with all of that money. Think about how many underfunded but necessary services could be bolstered to new heights. What if we all gathered around like crazed fanatics around a topic with true “give back” potential? Could you imagine if the Super Bowl commercial battle was not about who could pay the most, but who could change the most? What if our very own class video project could be viewed by millions and millions around the world, all at the same time? A Super Bowl commercial featuring (my secret, and not so secret obsession) of Ted Talks, or innovative ideas to help poverty, secure human rights, or provide sustainable food for the hungry? What about helping to reform our broken criminal justice system, election system, or education system for that matter? The possibilities are endless and the latent consequences of positive change are astounding.

Sigh. End rant. I need to get back to my Super Bowl party and give a good “piss poor coaching” yell on behalf of my dad. ;o)